BlueCross BlueShield of Tennessee Medical Policy Manual

Mechanized Axial Spinal Distraction Therapy Devices

DESCRIPTION

Mechanized axial spinal distraction therapy devices are generally marketed as a method for treating back pain. The basic mechanism of action involves a controlled distraction of vertebral bodies along the spinal axis for the purpose of reducing pressure along the spinal column (i.e., vertebral axial decompression). Generally, multiple treatments are administered over a period of time with the intent that the series of mechanized distractions will result in a considerable reduction in pain for a significant period of time. Mechanized, computer controlled tables are typically used to apply the distractive tension; the devices may also utilize other features such as harnesses, belts, and/or biofeedback. Mechanized axial spinal distraction therapy devices are used in the treatment of a number of conditions including, but not limited to, herniated discs, degenerative disc disease, sciatica, posterior facet syndrome, lumbosacral strain, radiculopathy, and a condition called internal disc disruption (IDD).

Mechanized axial spinal distraction therapy devices for the treatment of all indications, including but not limited to the treatment of back pain, are consideredinvestigational.

IMPORTANT REMINDERS

Any specific products referenced in this policy are just examples and are intended for illustrative purposes only. It is not intended to be a recommendation of one product over another, and is not intended to represent a complete listing of all products available. These examples are contained in the parenthetical e.g. statement.

We develop Medical Policies to provide guidance to Members and Providers. This Medical Policy relates only to the services or supplies described in it. The existence of a Medical Policy is not an authorization, certification, explanation of benefits or a contract for the service (or supply) that is referenced in the Medical Policy. For a determination of the benefits that a Member is entitled to receive under his or her health plan, the Member's health plan must be reviewed. If there is a conflict between the Medical Policy and a health plan, the express terms of the health plan will govern.

ADDITIONAL INFORMATION

There is insufficient published evidence demonstrating that the use of a mechanized axial spinal distraction therapy device renders a health benefit equal to, or greater than, other established alternatives (e.g., simple mechanical traction, flexion/distraction, inversion therapy). Many of the studies available are uncontrolled, or contain significant methodological flaws that undermine the validity of stated positive results. Well-conducted randomized, controlled trials are required in order to draw adequate conclusions as to the level of health benefit to be obtained by using these devices.

SOURCES

Agency for Healthcare Research and Quality. (2007, April). Decompression therapy for the treatment of lumbosacral pain. Retrieved February 9, 2011 from www.ahrq.gov.

Policies included in the Medical Policy Manual are not intended to certify coverage availability. They are medical determinations about a particular technology, service, drug, etc. While a policy or technology may be medically necessary, it could be excluded in a member's benefit plan. Please check with the appropriate claims department to determine if the service in question is a covered service under a particular benefit plan. Use of the Medical Policy Manual is not intended to replace independent medical judgment for treatment of individuals. The content on this Web site is not intended to be a substitute for professional medical advice in any way. Always seek the advice of your physician or other qualified health care provider if you have questions regarding a medical condition or treatment.